M. Konsta, MD, PhD, Department of Rheumatology and Immunology, Amsterdam UMC, Amsterdam, the Netherlands, and Department of Rheumatology Veterans Administration Hospital, Athens, Greece, and Joint Rheumatology Program, National Kapodistrian University of Athens Medical School, Athens, Greece.
M.T. Nurmohamed, MD, PhD, J.C. van Denderen, MD, PhD, I. Visman, PhD, Department of Rheumatology and Immunology, Amsterdam UMC, Amsterdam, the Netherlands.
J Rheumatol. 2023 Mar;50(3):342-350. doi: 10.3899/jrheum.220061. Epub 2022 Nov 1.
To examine the prevalence of hip involvement between sexes in patients with ankylosing spondylitis (AS) treated with tumor necrosis factor inhibitors (TNFi) and to estimate the effect of TNFi on radiographic progression of hip involvement compared to the spine.
Two hundred ninety-nine patients with AS treated with TNFi (215 men; median age: 43 yrs [IQR 36-52], median disease duration: 7.6 yrs [IQR 2-15]) were evaluated for hip involvement, defined radiographically as Bath AS Radiological Hip Index (BASRI-hip) score ≥ 2. Those who received TNFi for ≥ 2 years (263/299) were assessed for radiographic progression. Radiographs of the pelvis and spine, obtained at baseline (ie, before TNFi initiation), were compared retrospectively to those obtained after 2.5 (SD 0.7) years and 7.0 (SD 2.3) years of TNFi treatment. Both hips were scored by BASRI-hip score and mean joint space width (MJSW). Spinal radiographs were scored by modified Stoke AS Spinal Score (mSASSS).
The prevalence of hip involvement at baseline was 113/299 (38%) patients, of whom 87/215 (41%) were male and 26/84 (31%) were female ( = 0.10). In both sexes with hip involvement at baseline, BASRI-hip score and MJSW did not change significantly during follow-up. In males and females without baseline hip involvement, the BASRI-hip score remained unchanged after 2.5 (SD 0.7) years but increased significantly after 7.0 (SD 2.3) years, without reaching the cut-off of 2. In contrast, the MJSW slightly decreased at the 2 follow-up timepoints (ie, after 2.5 and 7.0 yrs). The mSASSS increased significantly during the follow-up in both sexes, regardless of hip involvement.
In our study, approximately one-third of patients with AS had hip involvement, which seemed to stabilize with TNFi treatment. No sex differences in the prevalence or progression of this manifestation were found.
研究接受肿瘤坏死因子抑制剂（TNFi）治疗的强直性脊柱炎（AS）患者中髋关节受累的性别差异，并评估 TNFi 对髋关节与脊柱影像学进展的影响。
共评估了 299 例接受 TNFi 治疗的 AS 患者（215 例男性；中位年龄：43 岁[IQR 36-52]，中位病程：7.6 年[IQR 2-15]）的髋关节受累情况，通过 Bath AS 放射学髋关节指数（BASRI-hip）评分≥2 来定义放射影像学髋关节受累。对接受 TNFi 治疗≥2 年（263/299）的患者进行影像学进展评估。回顾性比较基线（即 TNFi 治疗前）、治疗 2.5（SD 0.7）年和 7.0（SD 2.3）年后的骨盆和脊柱 X 线片。使用 BASRI-hip 评分和平均关节间隙宽度（MJSW）对双侧髋关节进行评分，使用改良 Stoke AS 脊柱评分（mSASSS）对脊柱 X 线片进行评分。
基线时髋关节受累的患者有 113/299（38%）例，其中 87/215（41%）例为男性，26/84（31%）例为女性（=0.10）。在基线时存在髋关节受累的男性和女性患者中，BASRI-hip 评分和 MJSW 在随访期间均无显著变化。在基线时无髋关节受累的男性和女性患者中，BASRI-hip 评分在治疗 2.5 年后（SD 0.7）时保持不变，但在治疗 7.0 年后（SD 2.3）时显著增加，未达到 2 的临界值。相反，MJSW 在这 2 个随访时间点（即治疗 2.5 和 7.0 年后）略有下降。在两性患者中，mSASSS 在随访期间均显著增加，无论髋关节受累情况如何。
在本研究中，约三分之一的 AS 患者存在髋关节受累，且接受 TNFi 治疗后髋关节受累似乎稳定。未发现这种表现的性别差异。
